Year : 2012 | Volume
: 6 | Issue : 2 | Page : 59--60
HIV/AIDS treatment in sub-Saharan Africa: Towards universal access and universal "test and treat" strategy
Mukhtar A Adeiza
Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Kaduna State, Nigeria
Mukhtar A Adeiza
Department of Medicine, Ahmadu Bello University Teaching Hospital, PMB O6, Shika, Zaria, Kaduna State
|How to cite this article:|
Adeiza MA. HIV/AIDS treatment in sub-Saharan Africa: Towards universal access and universal "test and treat" strategy.Ann Nigerian Med 2012;6:59-60
|How to cite this URL:|
Adeiza MA. HIV/AIDS treatment in sub-Saharan Africa: Towards universal access and universal "test and treat" strategy. Ann Nigerian Med [serial online] 2012 [cited 2020 Apr 5 ];6:59-60
Available from: http://www.anmjournal.com/text.asp?2012/6/2/59/108106
"No virus, no transmission." Studies have repeatedly shown that viral load (the quantity of virus present in blood, sexual secretions, and body fluids) is the strongest predictor of HIV transmission during unprotected sex or transmission from infected mother to child.  In resource-limited countries of sub-Saharan Africa, current guidelines recommend initiating highly active antiretroviral treatment (HAART) in HIV-infected individuals when CD4+ count drops below 350 cells/ml.  However, the concept of universal access and universal "test and treat" strategy has recently become topical and is gaining support among the more affluent countries of the world where resources may not be a constraint. This study is backed by findings of numerous researches and mathematical modeling studies that have been conducted in the past. ,,,
Treating HIV-infected individuals has both a therapeutic and a preventive effect, because treatment reduces viral load. Reducing viral load increases survival, but also decreases the infectivity of the individual.  As a result, by treating HIV-infected individuals, new HIV infections are prevented and transmission is decreased. Thus, HAART has come to acquire the potential for being both an individual-based intervention and a potential public health solution to the IDS pandemic.
So how will sub-Saharan Africa and the developing countries of the world fit into this strategy? According to World AIDS progress report 2011, there were a total 10.4 million HIV-infected individuals eligible for HAART in sub-Saharan Africa, but only 5 million received therapy, leaving a coverage deficit of 51%.  This gap must be bridged. Only then will an attempt at universal access be possible and only then will Africa be able to adopt the universal "test and treat" strategy.
The first step will involve changing attitudes and perception of people toward testing, and improving efforts to make HIV testing available to those at greatest risk on a wider scale. Currently, not all at risk individuals get tested because of the fear of stigma and discrimination.  In 2006, the U.S. Centers for Disease Control and Prevention's HIV testing recommendations suggested HIV screening for people ages 13-64 years in all health settings.  Ideally, screening should be conducted once a year. However, even where better resources are available, coverage still falls short of the expectations.
Second, widespread and immediate access to HAART after diagnosis will then be required. Unfortunately, even where treatment targets of CD4+ count <350 are used, optimal HAART coverage has still not been realized in the region and, as such, universal access is still a mirage. This is directly related to the disparity between the number of new infections requiring treatment every year and the available resources. Also, there is a need to intensify efforts to ensure adherence and maintain or retain people already diagnosed in care to achieve efficient viral load suppression at the community level to minimize transmission.
Therefore, the main impediment to the realization of universal access and the universal "test and treat" strategy in the region can be attributable to the limited resources available. International AIDS funding is said to be stagnant at about US $8.2 billion per year since 2009, while resource needs are increasing and are expected to peak at an estimated US $24 billion in 2015.  Most African countries therefore will have to look inward and dig deep to bridge this funding gap. For now, if current strategies are strengthened, transmission could still be reduced and the AIDS-free generation could still be realized.
|1||Ambrosini A, Clamy J, Hirschel B. HIV treatment for prevention. J Int AIDS Soc 2011;14:28.|
|2||WHO Rapid Advice: Antiretroviral therapy for HIV infection in adults and adolescents. 2009. Available from: http://www.who.int/hiv/pub/arv/rapid_ advice_art.pdf [Last accessed on 2012 Dec 23].|
|3||El-Sadr WM, Affrunti M, Gamble T, Zerbe A. Antiretroviral therapy: A promising HIV prevention strategy? J Acquir Immune Defic Syndr 2010;55(Suppl 2):S116-21.|
|4||Dieffenbach CW, Fauci AS. Universal voluntary testing and treatment for prevention. JAMA 2009;301:2380-2.|
|5||Dodd PJ, Garnett GP, Hallet TB. Examining the promose of HIV elimination by 'test and treat' in hyper-endemic settings. AIDS 2010;24:729-35.|
|6||Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for HIV elimination: A mathematical model. Lancet 2009;373:48-57.|
|7||Wagner BG, Blower S. Universal access to HIV treatment versus universal 'test and treat': Transmission, drug resistance and treatment costs. PLoS One 2012;7:e41212. |
|8||WHO, UNICEF and UNAIDS. Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access. Progress Report 2011. Available from: http:// whqlibdoc.who.int/publications/2011/9789241502986_ eng.pdf [Last accessed on 2012 Dec 24].|
|9||U.S. Centers for Disease Control and Prevention. CDC HIV/AIDS science facts: CDC releases revised HIV testing recommendations in health care settings. 2006. Available from: www.cdc.gov/hiv/topics/testing/resources /factsheets/healthcare.htm [Last accessed on 2012 Dec 24].|
|10||Sidibé M, Piot P, Dybul M. AIDS is not over. Lancet 2012;380:2059-60.|